PARENT STUDENT MANUAL4dfdcf5e39481c021811-ed5dbb7db8a55f1f885413697706bc29.r5.cf… · Just 6 miles...

PARENT STUDENT

MANUAL

OSS PARENT STUDENT MANUAL 2

ABOUT THE PROGRAM

The Mount Hermon Outdoor Science School seeks to increase awareness and scientific understanding of the natural world

through hands on lessons and concrete experiences while providing exposure to the outdoors.

OUR PRIMARY VALUES INCLUDE:

• Character Development (i.e. respect, self-confidence, teamwork)

• Stewardship

• Science Literacy

• Wonder of Nature

Our program offers an exciting, academic, hands-on science program based on the California Science Framework.

Students in 5th-8th grades actively participate in one week of outdoor science exploration while building confidence through

the distinct challenges that students face throughout the week. Numerous opportunities are given for students to increase

their awareness and understanding of our physical environment while encouraging good stewardship of our natural

resources.

FACILITIES & LODGING

Just 6 miles from the Pacific Ocean and Monterey Bay, Mount Hermon’s 440 acres rest in the middle of the coastal

redwoods, about 70 miles south of San Francisco, where the students are able to explore and learn in a dynamic

environment. Endless hiking trails are located in the adjacent Henry Cowell State Park where students can view ancient

redwoods or the unique sand hills that are distinct to this area.

Accommodations: Ponderosa Lodge has 24 cabins that are heated, carpeted and have full bathrooms (3 sinks, 2 showers

and 2 toilets). Each cabin has 4 bunk beds (sleeping 8) and one roll-a-way bed. Each student has an individual closet and a

drawer under the bunk.

Facilities and Grounds: Our Forum provides a central meeting area which is utilized for orientation, certain evening

activities and as a classroom. Recreation options include a game room, ping-pong, foosball, a 25 meter heated lap pool and

diving pool, basketball courts, sand volleyball court and a large field. Ponderosa lodge dining room has round tables that

serve 8 students family style meals.


WEATHER

The weather at Mount Hermon will often change rapidly! Students will be outdoors for much of the time, from 8 am till 9 pm.

They will need to bring layers and appropriate gear with them on all hikes and activities. If students come prepared, they will

have a much more enjoyable and comfortable time!

Temperatures can range from the 30’s to the 100’s. During the fall months, temps usually range from 50-80 during the day

and 40-60 at night, although temperatures outside this range are also normal. During the winter/spring months, temps dip

very low and we see the most rain.

Rain can occur on any day of the year. We get the most rain from late October through May. All participants are required to

bring rain gear of some sort such as a light poncho or waterproof jacket. If it rains, clothing gets wet and often stays wet.

Extra dry clothing is very important!

Wind occurs often and may cause students to become colder much more quickly. Warm layers are essential!

Clothing that every student must bring includes: rain gear, long pants, good hiking shoes or boots, an extra pair of shoes

and warm layers such as a long sleeve T-shirt, sweatshirt, or light jacket. A Wool or fleece hat can also go a long way to

keep the body warm.

Please see the student packing checklist on page 9 for a full packing list!

TEACHING STAFF

Mount Hermon provides naturalists who will instruct students during classes and night activities throughout the week. They

are the teachers of OSS and they are passionate about teaching in the great outdoors. The naturalists are hand selected by

the director of the program, and come with diverse backgrounds in education and science as well as distinct expertise and

passions that make them dynamic teachers in the field.

ALL OF OUR NATURALIST HAVE THE FOLLOWING

A College Education

Experience working with children

First Aid/CPR certifications

Ability to lead hikes and outdoor activities

To see photos of our naturalists, please visit our website at outdoorscience.com.


CLASSES & ACTIVITIES

Each day is filled to the brim with fun and educational experiences. Our classes are all based on the California State

Science Standards and will stimulate students to become good stewards as well as promote team building. Each class

includes at least one chaperone and varies from 14-18 students in size.

CONSUMERS:

Students will learn to identify different types of

consumers and how they interact with their environment.

Class activities include observation of birds in the bird

sanctuary, interactive modeling of the food web, and the

study of snakes in our Lab.

ADVENTURE HIKE:

One day a week, the students take an all-day adventure

through the many acres that surround our facilities. This

hike expands across 4 different ecosystems, taking the

students through the redwoods, over the sand hills, by

the creeks and to secret lunch spots on river beaches.

ECOSYSTEMS/PRODUCERS:

Throughout this class students will grow in their

knowledge of how photosynthesis drives plant growth

and development as well as what role plants play in

ecosystems. Students will be introduced to the local flora

and edible plants.

CLIMBING TOWER:

The Climbing Tower provides a wonderful chance for

students to conquer their fear of heights and learn about

setting and obtaining reasonable goals for themselves,

while having fun!

NIGHT HIKE:

As the sun sets and the stars and moon appear,

students begin an exciting evening of learning how their

night vision works, what nocturnal animals are, and all

about the night sky. Students are faced with the

challenge of hiking at night in a safe and supportive

environment.

CAMPFIRE:

This is a great time for the students to relax and have a

good time singing as skits and songs are performed by

the naturalists. The night concludes with a campfire story

and a yummy s’more cooked over the open campfire.

WATERSHED STEWARDSHIP:

Students begin by learning about the basics of a

watershed then hike through a portion of our watershed,

through the riparian corridor and finish at Bean or

Zayante Creek. At the creek, students explore concepts

and look for specific attributes that make a creek

healthy.

CLUE:

This evening activity focuses on problem solving and

deductive reasoning. Students move from station to

station around camp, with their cabin, to question

different suspects and ultimately solve the mystery of the

“squirrel napping”.

ELECTIVES:

Electives are a fun time where students can learn about

additional activities that cater to personal interests. A few

example electives include: basket weaving, candle and

chap-stick making, art with nature, rockets, survival, and

field games.

SKIT NIGHT:

The last night of the week is a chance for the students to

practice their public speaking and dramatic skills as they

perform skits that they have been preparing all week

during their cabin time. Each cabin group is assigned a

skit topic relating to something learned throughout the

week.

DAILY SCHEDULE SAMPLE

Outdoor Science School is packed full of educational and fun activities. The day runs on a tight schedule so that the most

learning can be accomplished.

7:00AM................................ Day Begins

7:55–8:00AM................... Line Up/Flag Raising

8:00–8:45AM.................... Breakfast

8:45–9:10AM.................. Class Prep*/Cabin Time (Posters/Skits)

9:10–11:20AM.................. Line Up/Class

11:20–11:45AM.............. Cabin Time

11:45–12:00NOON.......... Line Up/Pre-Lunch Announcements

12:00–12:45PM.............. Lunch - Posters Due Wednesday

12:45–1:10PM.............. Class Prep*/Cabin Time (Posters/Skits)

1:10-3:20PM................... Line Up/Class

3:20–3:45PM.................... Prepare for Recreation Time in Cabins

3:45–4:50PM................... Student Recreation Time

4:50–5:25PM.................... Cabin Time

5:25–5:30PM.................. Line Up/Lowering of the Flag

5:30–6:15PM.................. Dinner

6:15–6:45PM.................... Class Prep*/Cabin Time (Posters/Skits)

6:45–7:15PM.................... Line Up/Game/Teacher Meetings

7:15–9:00PM.................... Evening Activities

(Campfire/Night Hike/Clue/Skit Night)

9:00–10:00PM.................. Prepare for Bed/Lights Out 10:00

SCHEDULE NOTES:

MONDAY starts around 10:30AM

FRIDAY ends around 10:30AM

WEDNESDAY (for a 5 day week) has electives as the

second class of the day

THURSDAY is Adventure Hike. Students are on the

trail from 9:30AM–3:00PM

CABIN CHECK is during the first class period

*Class Prep Time = Go to the restroom, get

backpack, water bottle, pencil, student book, long

pants, hiking shoes, warm clothes, rain gear,

sunscreen, any other needed materials.

FOOD AND DINING

Mount Hermon maintains a full time kitchen staff serving thousands of guests per year. At each meal, each food item is

served separately and individuals with common dietary needs (e.g. dairy free, gluten free, vegetarian) are typically able to

find suitable options. We provide a full salad bar at dinner as well as gluten free, dairy free and vegetarian options at each

meal.

Mount Hermon is a nut safe facility meaning that although we are not completely nut free, the meals we prepare do not

contain nuts.

Please make sure to indicate any dietary needs your student may have on page 2 of the MINOR HEALTH FORM found at

the end of this packet. If your student has extensive dietary needs or allergies, please contact us to request a sample menu

or discuss specific needs.


PARENT COMMUNICATION WITH STUDENTS

To avoid homesickness and maintain a safe environment, Mount Hermon is a closed campus. Parents may NOT visit or

drop of items/packages. Additionally, students are not allowed to call home or receive calls from their parents. We

recommend sending hand written letters - not emails to your student. Please do not send “care packages” to your student

including any amount of food, candy or toys. Parents that send mail to Outdoor Science School need to make sure it will be

received by Friday morning. We recommend sending mail to your student one week in advance and we will hold it until they

arrive. If students plan to write to their parents, make sure they come with pre-addressed and stamped envelopes.

Return Address Stamp

Student’s Name

Outdoor Science School – Ponderosa Lodge

PO Box 413

Mount Hermon, CA 95041

Your School Name (i.e. Mesa Elementary)

HEALTH & SAFETY

One of our health aids, who are certified in Red Cross CPR and Adult First Aid, is on duty from 7:30am – 10:00pm every

day. Our Registered Nurse is present every day to dose all medications and as needed to dispense over the counter

medication. The Health Center is fully stocked with all the basic medication and equipment, a phone, two beds, a bathroom,

and a shower. If further assistance is needed, an emergency medical clinic is located in Scotts Valley, 5 minutes away, and

a full service hospital is located 20 minutes away.

By law, students may not keep any medications with them, and they may not dispense medications to themselves. This

includes any over the counter medications such as Tylenol, Ibuprofen, antacids, creams, ointments, and food supplements

as well as any prescription medications. Our Registered Nurse will dose all these medications at the correct times. Asthma

inhalers are kept in the nurse’s station and may be picked up prior to hiking or strenuous activity.


Please be sure that all students are in good general health before arriving. A student will be promptly sent home for any of

the following health issues:

Vomiting more than once

Signs and symptoms of a fever

Temperature above 100.4 degrees

Signs of a contagious disease or lice

Missing more than 1 class

If a student has been sent home for a medical reason, they must be symptom free for at least 24 hours and cleared through

their doctor before returning to camp.

If you are sending any prescription medication with your student you must have all the medical information available on both

the bottle and you must have the PRESCRIPTION MEDICATION FORM at the end of this packet completely filled out. All

medications MUST be in their original packaging. Please place all medications in a one gallon clear plastic Ziploc bag and

label the bag with the student’s name. This bag must be turned in to the teacher before arriving at Mount Hermon.

Unless the student has a medical condition requiring regular dosing each day, Parents DO NOT need to send the over the

counter (OTC) medications listed below. Our Health Center is well stocked with these medications and if needed students

will be given the proper doses of these OTC medications. We are ONLY able to dispense these medications if approved by

the parent/guardian on page 2 of the MINOR HEALTH FORM.

OVER THE COUNTER MEDICATIONS PROVIDED AS NEEDED IN THE HEALTH CENTER:

Acetaminophen (Tylenol)

Ibuprofen (Advil, Motrin)

Diphenhydramine (Benadryl)

Technu Extreme (Poison Oak skin wash)

Guaifenesin DM (Cough Medicine)

Medicane Swab (Sting Relief)

Antibiotic Ointment

Hydrocortisone Cream

Antacids (Tums)

Aloe Vera Lotion

Loratadine (Claritin)

Cough Drops

It is extremely important that parents review and thoroughly fill out the MINOR HEALTH FORM at the end of this packet. If

you anticipate that your student will require additional health related assistance while at camp please be sure to

communicate these needs to your school well in advance.


RESPONSIBILITIES & EXPECTATIONS OF STUDENTS

Outdoor Science School is just that… a school. Students will be required to follow certain rules and will be expected to have

the needed supplies to make their time an exciting educational experience!

PACKING

Students will need to review and pack according to the attached student packing checklist on page 9 of this manual. Please

note that most items are mandatory and must be packed! Students are NOT ALLOWED to bring electronic devices or

weapons of any kind. This includes items such as cell phones, iPods, and pocketknives! Both parents and students are

encouraged to read the packing checklist carefully.

DISCIPLINE

Students are under continuous supervision by their cabin leader and naturalist during the Outdoor Science School week.

For minor disciplinary issues students will be given 5–10 minute time-outs from their afternoon Recreation Time.

If discipline issues occur that require more discipline or if the student acquires more than 15 minutes of time-out, the

student’s parents will be contacted. Additionally, the teacher along with OSS admin will meet with the student and assign

them a task for a portion or all of Recreation Time.

If the student breaches one of the below actions the student will be promptly sent home. In this situation, the student’s

parents will be contacted and will need to pick them up. In the event that a student needs to be sent home for any reason,

no amount of the paid fees will be refunded if the student has attended the program for 24 hours or more.

The following breaches of discipline are grounds for immediate dismissal from Mount Hermon’s Outdoor Science School

program:

Fighting

Unauthorized leaving of cabin

Any activity that is inherently dangerous to self or

others

Possession of illegal substances

Stealing

Possession of any weapons whatsoever

Cabin raiding/pranking

Bullying

Outright defiance

Intentionally destroying property

Other behaviors at the discretion of the Director of the

Outdoor Science School


STUDENT PACKING CHECKLIST

REQUIRED ITEMS

Sleeping Bag & Pillow

2 Pairs Long Pants

Extra Socks

2 Towels

Backpack

Rain Gear

(Rain Jackets, Ponchos, Rain Pants, Boots)

2–3 Pairs of Closed-Toe Shoes

Toiletries (Including Sunscreen)

2 Pencils

Pajamas

Warm Jacket & Sweatshirt

Laundry Bag (Trash Bag Works)

Water Bottle (1 Quart/Liter)

Outdoor Clothing

Flashlight

PLEASE DO NOT BRING

Extra Food or Beverages (except for medical reasons)

Knives, Firearms or Other Weapons

(including pocket knives)

Cell Phone

Any Money besides T-Shirt/bag Money

Electronic Games or Radios

Drugs, Alcohol or Tobacco Products

OPTIONAL ITEMS

Disposable Camera

Lip Balm

Watch/Alarm Clock

Writing Materials For Letters & Stamps

Bathing Suit (one piece bathing suits only)

$12 for T-Shirt*

$5 for Draw String Bag*

*either cash or check (make checks out to Mount Hermon)

FORMS THAT MUST BE SIGNED BY A PARENT OR GUARDIAN BEFORE COMING

Minor Health Form

Prescription Medication Form (ONLY if bringing prescription medications)

Participant/Guardian Waiver Form

MOUNT HERMON OUTDOOR SCIENCE STUDENT CONTRACT

We are excited that you are going to spend a week with us soon! Our commitment is to provide meaningful experiences,

fun learning opportunities, and safe adventures. If you choose to participate in your school’s week at Mount Hermon

Outdoor Science School, we ask that you make a commitment of your own: to live by the following guidelines. If you can

agree to this contract, please put your initials next to each item and sign at the bottom. Thanks!

GENERAL AGREEMENTS

_____ I agree to fully participate in my school’s week of Outdoor Science School.

_____ I agree to be on time for all activities.

_____ I agree to respect the privacy, property, and feelings of others. I understand that we’ll be living together in cabins

and sharing the campus.

_____ I agree to treat my fellow students, cabin leaders, teachers, and naturalist with respect. I understand that how I talk

to people is important. I will also do my best to be respectful when someone is talking to me, whether it’s a cabin

leader, naturalist or my best friend.

_____ I agree to follow my Student Packing List and bring the things I’ll need for my stay (like raingear, a leak-proof water

bottle, extra clothes, etc.)

_____ I agree to stay out of other students’ cabins.

_____ I agree to be quiet and respectful in the evening so that everyone can get enough sleep to participate and stay

healthy.

_____ I agree to keep food out of my cabin.

BOTTOM-LINE AGREEMENTS

I understand that a violation of any one of the following or a combination of the above contract agreements may

result in a return trip home at my parent/guardian’s expense.

I agree to not do any of the following during my stay at Mount Hermon Outdoor Science School:

_____ Fighting

_____ Any activity that is inherently dangerous to self

or others

_____ Stealing

_____ Cabin raiding/pranking

_____ Outright defiance

_____ Intentionally destroying property

_____ Unauthorized leaving of cabin

_____ Possession of illegal substances

_____ Possession of any weapons whatsoever

_____ Bullying

_____ Other behaviors at the discretion of the Director of

the Outdoor Science School

________________________________________ _______________

Signature Date

Student’s Name: _______________________ School: _______________________ Teacher: ______________________

MINOR HEALTH FORM PAGE 1 of 3

MOUNT HERMON MINOR HEALTH FORM

Dates attending OSS: from __________________________ to __________________________ Month/Day/Year Month/Day/Year

Student Name ________________________________________________________________ First Middle Last

Male Female Birth Date _______________________ Age at OSS ________ Month/Day/Year

School _______________________________________________________________________

To Parent(s)/Guardian(s): Please complete all pages and sections of this form and make a copy! GIVE the original, signed forms to the school teacher. Please keep the copy for your records.

Outdoor Science School P.O. Box 413 MOUNT HERMON, CA 95041

Student Home Address _______________________________________________________________________________________ Street Address City State Zip

Parent/Guardian with legal custody to be contacted in case of illness or injury

Name ______________________ Relationship ________________ Preferred Phones (____)_____________ (____)_____________

Home Address ______________________________________________________________________________________________ (if different from above) Street Address City State Zip

Second Parent/Guardian with legal custody to be contacted in case of illness or injury


Additional contact in event parent(s)/guardian(s) can’t be reached


MEDICAL INSURANCE INFORMATION

This student is currently covered by a health insurance plan Yes No

Include a copy of your insurance card; copy both sides of the card so information is readable.

Insurance Company___________________________ Policy Number__________________________

Subscriber __________________________________ Insurance Company Phone Number (____)_____________

If you do not have health insurance please read and sign below.

If you do not have your own health care plan, we can provide insurance to your student while at camp. We are insured through Harford Life and Accident Insurance Company. By signing below you authorize payment of any medical fees to physician or supplier for services described on any attached statements to be disclosed to Harford Life and Accident Insurance Company for the fees to be paid. My consent is hereby granted to use this original or a photo static copy as equally valid authorization.

Signature of Custodial Parent/Guardian__________________________ Date____________ Relationship to Student______________

HEALTH-CARE PROVIDERS

Name of student’s primary doctor(s) ______________________________________________ Phone (____)_____________

Name of dentist(s) ____________________________________________________________ Phone (____)_____________

Name of orthodontist(s) ________________________________________________________ Phone (____)_____________

PARENT/GUARDIAN AUTHORIZATION FOR HEALTH-CARE

This health history is correct and accurately reflects the health status of the student to whom it pertains. The person described has permission to participate in all Mount Hermon Outdoor Science School activities except as noted by me and/or and examining physician. I give permission to the physician selected by Mount Hermon Association to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with OSS staff. I give permission to photocopy this form. In addition, Mount Hermon Association has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status. I am aware that, at the discretion of the Science School Director, I will need to pick up my child due to medical or disciplinary reasons. I agree to be responsible for picking up my child. Mount Hermon Outdoor Science School policy is that in the event that a child needs to be sent home for any reason, no amount of the paid fees will be refunded if my child has attended the Outdoor Science School program for 24 hours or more.

Signature of Custodial Parent/Guardian__________________________ Date____________ Relationship to Student______________




DIET, NUTRITION This student eats a regular diet

This student eats a regular vegetarian diet

This student has special food needs (Please describe below)

Note: Our kitchen will do its best to provide for special food needs. However, if your student has extensive dietary needs, please contact us to discuss the menu. You may need to send additional food with your student.

RESTRICTIONS This student has permission to go swimming while at Outdoor Science School

This student does not have permission to go swimming while at Outdoor Science School

I have reviewed the program and activities of OSS and feel the student can participate without restrictions.

I have reviewed the program and activities of OSS and feel the student can participate with the following restrictions or adaptations. (Please describe below)

ALLERGIES No known allergies

This student is allergic to: Food Medicine The environment (insect stings, hay fever, etc.) Other

Please describe any allergies and the reaction seen

MEDICATION This student will not take any daily medications while attending Outdoor Science School

This student will take the following daily medication(s) while at Outdoor Science School

“Medication” is any substance a person takes to maintain and/or improve their health. This includes vitamins and natural remedies. By law, all prescriptions and over the counter medication must arrive in the original and appropriately labeled pharmacy containers. ALL medications must be turned in to the Health Center upon arrival. The Health Center staff will store and distribute medications as directed/needed.

Name of Medication Date Started Reason for Taking it When is it Given Amount or Dose Given How it is Given

Breakfast

Lunch

Dinner

Bedtime

Other ________

Breakfast

Lunch

Dinner

Bedtime

Other ________

Breakfast

Lunch

Dinner

Bedtime

Other ________

The following non-prescription medications are representative of what may be stocked in the Health Center and are used on an AS NEEDED BASIS to manage illness and injury.

Cross out those the student should NOT be given

Acetaminophen (Tylenol) Guaifenesin DM (Cough Medicine) Tums

Ibuprofen (Advil, Motrin) Docusate Sodium (Stool softener) Aloe Vera Lotion

Pseudoephedrine (Sudafed) Medicane Swab (Sting Relief) Cough Drops

Diphenhydramine (Benadryl) Antibiotic Ointment

Technu Extreme (Poison Oak skin wash) Hydrocortisone Cream




IMMUNIZATION HISTORY

Provide month and year for each immunization. If that immunization has not been received write “none” in the space provided

Immunization Dose 1

Month/Year Dose 2

Month/Year Dose 3

Month/Year Dose 4

Month/Year Dose 5

Month/Year Most Recent Dose

Month/Year

Diptheria, Tetanus, Pertussis (DTaP) or (TdaP)

Tetanus Booster (dt) or (TdaP)

GENERAL HEALTH HISTORY Check “Yes” or “No” for each statement.

1. Ever been hospitalized? ..................................................... 2. Had fainting or dizziness? .................................................. 3. Ever had surgery? .............................................................. 4. Passed out/had chest pain during exercise? ..................... 5. Have recurrent/chronic illnesses? ...................................... 6. Had mononucleosis (mono) during the past 12 months? .. 7. Had a recent infectious disease? ....................................... 8. If female, had problems with periods/menstruation? .......... 9. Had a recent injury? ........................................................... 10. Have problems falling asleep/sleepwalking? ...................

Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

11. Have asthma/wheezing/shortness of breath? ............ 12. Ever had back or joint problems? .............................. 13. Have diabetes? .......................................................... 14. Have a history of bedwetting? .................................... 15. Had seizures? ............................................................ 16. Have problems with diarrhea/constipation? ............... 17. Have headaches? ...................................................... 18. Have any skin problems? ........................................... 19. Wear glasses, contacts, or protective eyewear? ........ 20. Traveled outside the country in the past 9 months? ..

Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

Will this student bring an inhaler to Outdoor Science School? Yes No

Will this student bring an Epi-Pen to Outdoor Science School? Yes No

Please explain “Yes” answers in the space below, noting the question number and if the student is currently under treatment for that specific item. For travel outside of the country, please name the countries visited and dates of travel.

MENTAL, EMOTIONAL, AND SOCIAL HEALTH Check “Yes” or “No” for each statement.

1. Has the student ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactive disorder (AD/HD)? ... 2. Ever been treated for emotional or behavioral difficulties or an eating disorder? ................................................................... 3. During the past 12 months, seen a professional to address mental/emotional health concerns? .......................................... 4. Had a significant life event that continues to affect daily life and functioning? .......................................................................

(History of abuse, death of a loved one, family change, adoption, foster care, new sibling, survived a disaster, etc.)

Please explain “Yes” answers in the space below; noting the question number.

Yes No Yes No Yes No Yes No

WHAT HAVE WE FORGOTTEN TO ASK? Please provide in the space below any additional information about the student’s health that you think important or that may affect their ability to fully participate in the Outdoor Science School program. Attach additional information if needed.

MOUNT HERMON OUTDOOR SCIENCE SCHOOL

PRESCRIPTION MEDICATION FORM

To be filled out if and only if a student or cabin leader under the age of 18 is bringing prescription medication to science school.

All medications and a copy of this form should be placed in a zip-lock storage bag, labeled legibly with the student’s first and last name,

and given to the classroom teacher on Monday prior to boarding the bus for Outdoor Science School. Teachers are responsible for

bringing any and all student medications to the nurse. NO medications should arrive at science school in student luggage.

EDUCATION CODE 49423 REQUIRES:

• Signed order from your physician, and parent consent. (Use form below.)

• Signed parent’s permission for camp medic or director to assist in carrying out the physician’s instructions

• Medication in a bottle from the pharmacy labeled with child’s name, dosage, and generic name of the drug. (Ask the

pharmacist for two bottles of medication: one for home and the other for Science School.) All OTC (Over The

Counter) medication sent to Science School must be labeled with the child’s name, the medication name and

dosage, as well as times to be given.

NO UNLABELED MEDICATION CAN BE ADMINISTERED.

EDUCATION CODE 49480

Gives the school medic, with parent consent, permission to communicate with the physician and counsel with the Science

School personnel regarding possible effects of medication.

PLEASE SIGN BELOW

Your signature indicates your consent as required in the above Education Code Sections 49423 and 49480.

Parent/ Guardian Signature

TO BE COMPLETED BY PHYSICIAN Date

has medication to be taken at the Mount Hermon Outdoor Science School. MEDICATION DOSAGE FREQUENCY PRECAUTIONS, SPECIAL INSTRUCTIONS, POSSIBLE ADVERSE EFFECTS, COMMENTS

Physician Signature Address Phone

TO BE COMPLETED BY PARENT/GUARDIAN

has my permission to take the above medication to Outdoor Science School and for

the Nurse or Director to assist and/or allow him/her to take the above medication as indicated for:

Parent/Guardian Signature Date

PARTICIPANT/GUARDIAN WAIVER FORM School

Please read this document carefully. It must be signed by all Mount Hermon Outdoor Science School Participants. Since the participant is a minor, at least one parent or guardian must also sign as evidence of their agreement to these terms and conditions on their own behalf and on behalf of the minor.

1. I acknowledge that I have voluntarily applied to participate in the Mount Hermon Outdoor Science School program

operated by Mount Hermon Association, Inc. which can be a physically demanding and/or challenging program. Students may participate in standard Outdoor Science School activities with manageable medical conditions. However, if I am participating in the Redwood Canopy Tour Zip-line, I do not have any medical conditions which might create an unsafe risk to myself or others who are participating in this activity with me.

2. ACKNOWLEDGEMENT OF RISKS

I understand that the Mount Hermon Outdoor Science School at Mount Hermon may expose participants to certain risks. The activities require moderate physical exertion and may be conducted at heights up to 150 feet (Redwood Canopy Tour Zip-line). Among the hazards and risks of the activities and use of the premises and equipment are the following: falls; collisions; abrupt and possibly harmful contact with structures, objects and persons; anxieties and fears associated with heights; close contact with other people; coordination and misjudgments on the part of participants; the failure of structures or equipment; and the unpredictable forces of nature. Participants may experience increased heart rate and other symptoms of anxiety and stress due to physical exertion, reliance on other participants, a fear of height, or of unprotected falling, loss of balance, coordination and misjudgments, including failure to follow procedures and instructions, physical or mental or psychological stress, fatigue, chill and /or dizziness which may diminish reaction time and increase the risk of an accident. Injuries associated with participation may include breaks, sprains, bruises, and in extreme cases, emotional upset, anxiety and even death. Participants acknowledge that the description of risks is not complete and that other unknown or unanticipated risks may result in injury, illness or death. Participants acknowledge that this program is purely voluntary, and with full knowledge of the inherent risks of the activities.

3. ASSUMPTION OF RISKS

I understand that participation in the Mount Hermon Outdoor Science School entails certain risks. I am voluntarily participating in this program with knowledge of the risks involved. I hereby accept any and all risks of injury or death to myself or any minor children for which I am responsible, arising out of or in any way connected with the use of the program, the Mount Hermon Adventure facilities, and/or one of affiliated organizations of Mount Hermon Association, Inc.

4. RELEASE AND INDEMNITY

As consideration for being permitted to participate in the Mount Hermon Outdoor Science School, I hereby agree that I, my assignees, heirs, and/or as the parent/guardian of a minor participant, will release and hold harmless and not bring any claim or legal suit against Mount Hermon Association, Inc., its directors, managers, officers, agents, employees and volunteers or its affiliated organizations or the supplier of any of the equipment used in the activity (“Released Parties”), for any and all claims of injury, disability, death or other loss or damage to person or property suffered by me or my minor child arising in whole or in part from participation in this program, both foreseeable or unforeseeable.

In addition, I agree TO INDEMNIFY (that is, defend and satisfy by payment or reimbursement, including costs and attorney’s fees) Released Parties from any claim of loss, injury or death, brought on by myself or my child against another co-participant. These agreements of release and indemnity include loss or damage caused or claimed in whole or in part by the negligence of a Released Party, but not intentional wrongs or the gross negligence of a Released Party.

(please initial) This student has permission to fill out a survey about his/her experience in nature. This is a voluntary survey and the student may stop at any time. The information from the survey is confidential and anonymous.

I HAVE CAREFULLY READ THIS VOLUNTARY PARTICIPATION AGREEMENT FORM AND PARTICIPANT REQUIREMENTS AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY IN WHICH I AM GIVING UP IMPORTANT LEGAL RIGHTS AND A CONTRACT BETWEEN MYSELF AND MOUNT HERMON ASSOCIATION, INC. AND/ OR ITS AFFILIATED ORGANIZATIONS, AND SIGN IT OF MY OWN FREE WILL. Print Parent/Guardian Name Signature Date Student Participant Name Signature Date

MOUNT HERMON

MAIN OFFICE 37 Conference Drive

Mount Hermon, CA 95041 831.335.4466 (Switchboard)

PONDEROSA LODGE 4600 Graham Hill Road Mount Hermon, CA 95041 831.430.1297 (OSS Main Office)

PARENT STUDENT MANUAL4dfdcf5e39481c021811-ed5dbb7db8a55f1f885413697706bc29.r5.cf… · Just 6 miles...

Documents

Transcript of PARENT STUDENT MANUAL4dfdcf5e39481c021811-ed5dbb7db8a55f1f885413697706bc29.r5.cf… · Just 6 miles...